O&G · Antenatal care — perinatal mortality
Stillbirth prevention
Also known as Late gestation stillbirth prevention · Safer Baby Bundle · Stillbirth risk reduction · Fetal death prevention · Perinatal mortality reduction
Exam-exhaustive FRANZCOG fellowship reference on stillbirth prevention — the Safer Baby Bundle's five elements (smoking cessation, fetal growth restriction detection, decreased fetal movements response, side-sleeping from 28 weeks, timing of birth) with their evidence, the PSANZ perinatal mortality classification, risk-factor stratification, the late-preterm/early-term birth decision, and the NHMRC Stillbirth CRE framework. RANZCOG-primary, globally tagged to MRCOG and ABOG.
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Target exams
Red flags
- A woman reports reduced or absent fetal movements — assess now with a CTG, never reassure on history alone
- Most stillbirths occur in women with no identified risk factor — the bundle is universal, not risk-selected
- Supine going-to-sleep position after 28 weeks — doubles the risk of late stillbirth; advise side
- An unexplained stillbirth without autopsy or placental histology leaves recurrence risk undefined
- AFFIRM increased intervention without cutting stillbirth — iatrogenic prematurity is the trade-off of a movements care package
A woman is 36 weeks into her first pregnancy and asks what she can do to keep her baby safe. The honest answer is that the single biggest determinant of late stillbirth is whether her maternity service delivers a bundle of evidence-based care consistently — and that her own actions, asked of every woman, are part of it. This topic is that conversation, written for the consultant who must defend it at the bedside and at the exam.[1][3]
Overview and definition
Stillbirth is a fetal death after a gestational threshold that varies by setting but the numbers you quote at the exam matter. [4][9]
- Australia: fetal death at 20 weeks' gestation or 400 g birthweight (used for national reporting); late gestation stillbirth is death at 28 weeks or more — the SBB's target window.[1][9]
- WHO / international: 28 weeks or more, or 1000 g, with 22 weeks / 500 g used in many high-income definitions.[4]
- Neonatal death is a live birth with subsequent death within 28 days; perinatal mortality brackets both stillbirth and early neonatal death.[4]
The number that launched the bundle: in 2015, Australia's late gestation stillbirth rate was 35% higher than the countries with the lowest rates globally — a gap framed as preventable and closing slowly, which is why the Stillbirth Centre of Research Excellence (CRE) built the SBB.[1]
References12ShowHide
- [1]Andrews CJ, Ellwood D, Middleton PF, et al. Implementation and evaluation of a quality improvement initiative to reduce late gestation stillbirths in Australia: Safer Baby Bundle study protocol BMC Pregnancy Childbirth, 2020.PMID 33187483
- [2]Heazell AEP, Andrews C, Flenady VJ Care Bundles to Reduce Stillbirths and Improve Pregnancy Outcome Clin Perinatol, 2026.PMID 41708224
- [3]Silver RM, Reddy UM Prevention of Stillbirth Clin Perinatol, 2026.PMID 41708223
- [4]Flenady VJ, Wojcieszek AM, Astell C, et al. Classifying Stillbirths and Neonatal Deaths to Inform Prevention Strategies Clin Perinatol, 2026.PMID 41708222
- [5]Norman JE, Heazell AEP, Rodriguez A, et al. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial Lancet, 2018.PMID 30269876
- [6]Cronin RS, Li M, Thompson JMD, et al. An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth EClinicalMedicine, 2019.PMID 31193832
- [7]Wilson DL, Whenn C, Barnes M, et al. A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial BJOG, 2025.PMID 39279669
- [8]Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis Lancet, 2011.PMID 21496916
- [9]Sexton JK, Mahomed K, Marsden T, et al. Prospective cohort study: Causes of stillbirth in Australia 2013-2018 Aust N Z J Obstet Gynaecol, 2021.PMID 33872393
- [10]Howell A, Thilaganathan B, Margelyte R, et al. Why current risk factor-based approaches fall short in predicting stillbirth: a national cohort study of nulliparous women in England BMC Med, 2026.PMID 41572249
- [11]Freijah I, Jones KA, Coleman T, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy Cochrane Database Syst Rev, 2026.PMID 42011820
- [12]Mayakaduwage KLB, Farrell T, Selvaratnam RJ, et al. Reach and Impact of the Safer Baby Bundle Among Groups Disproportionately Affected by Stillbirth in Victoria, Australia Aust N Z J Obstet Gynaecol, 2026.PMID 41416529